Inequality in Health: A Health Promotion perspective on the access to health of the socially marginalised

The overall purpose of the research we want to present, is to discuss how social inequality in health can both be maintained and strengthened- and changed through the health system and health efforts. Our contribution provides a view of a special point of intersection in which the health system – as a system and organisation – meets the everyday life perspectives and experiences of socially marginalised people. The group of people in focus are drug users, and they are here regarded from their everyday life, as people who are, in principle, strangers to, and outside the system that they meet. The health system has certain goals, rationalities and conditions for practice based on the medical paradigm, institutional logics, professional cultures and New Public. The health needs of the socially marginalised are, on the other hand, woven into complex social issues in which social and health aspects cannot be separated. Their conditions and needs are different and separate from the way the health system perceives of the “average” patient, and this is demonstrated in the encounter between this group of citizens and the health system. We will present short examples of how the health and welfare goals of the socially marginalised are made invisible, repressed and even stifled. Marginalised people are explicitly categorised as socially deviant and implicitly as pathological deviants without the resources to promote their health, and with less right to health.